Pharm Unit 6 Book Quiz

Name: Pharm Unit 6 Book Quiz
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Author: Daniel Miller

Unit 6 quiz on GI medications for APNs, covering mechanisms of action for loperamide and best laxative choices post-surgery. Includes rationales for selecting appropriate pharmacologic treatments. Ideal for advanced nursing pharmacology review.

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UNIT 6 BOOK QUIZ
Question 1 . The APN understands that loperamide works by which
mechanism?
• 1. Supplying missing bacteria to the gastrointestinal (GI) tract
. correci2. Decreasing gastric and bowel motility
• 3. Coating the wT
alls of the gastrointestinal (GI) tract and binding to
toxins
. 4. Stimulating peristalsis and gastric motility
Rationales
• Option l:This describes the mechanism of a probiotic.
■ Option 2:Loperamide binds to the opiate receptors of the intestine,
leading to a decrease in gastric and intestinal motility.
• Option 3:This describes the mechanism of an adsorbent.
. Option 4:This describes the mechanism of a stimulant laxative or
pro kinetic agent.
[Page Reference: 485]
Question 2 . A patient underwent sternotomy and coronary artery bypass
surgery yesterday. It is important to avoid straining for a bowT
el movement
postoperative ly. Which laxative would be the best choice for this type of
patient?
• 1 . Psyllium
. 2.Lubiprostone
• 3. Methylnaltrexo ne
• correct4. Docusate
Rationales
• Option 1:Bulk-forming laxatives are used for simple, chronic
constipation.
• Option 2:Lubiprostone is used for women who have irritable bowT
el
syndrome (IBS) with constipation.

Option 3:Methylnaltrexone is used for treating constipation from
chronic opioid use.
• Option 4:Surfactants. or "stool softeners." are commonly prescribed
postoperatively to prevent straining and the resultant pressure on the
surgical incision.
[Page Reference: 5161
Q u e s t i o n s . Many patients, particularly older adults, take over-the-counter
(OTC) laxatives regularly. Which statement about laxative use is accurate?
. 1. Patients cannot become dependent on laxatives.
• corrects. Fluid and electrolyte imbalances can occur.
• 3. Persons with Crohn's disease often abuse laxatives and take too
many.
• 4. Castor oil is good choice of laxative for a pregnant woman.
Rationales
• Option l:This is untrue. Many patients become dependent on
laxatives for a bowel movement, particularly with the overuse of
stimulant laxatives.
• Option 2:This is especially true of older adults using bulk-forming
laxatives or hyperosmolar agents.
■ Option 3: Laxative abuse is commonly seen in those with personality
disorders and women with depression or anorexia nervosa.
• Option 4:Castor oil induces uterine contractions and should not be
used.
[Page Reference: 5 1 6 ]
Question 4. A patient with a body mass index (BMI) of 28 has recently
been diagnosed with gastroesophageal reflux disease (GERD), and
omeprazole has been prescribed. Which advice would the APN give this
patient regarding lifestyle changes?
• l."You should eat meals high in carbohydrates."
• 2. "Small amounts of alcohol are OK."

corrects. "Attaining a healthy weight will help reduce symptoms of
GERD."
4. "Drinking peppermint tea before bed will help."
Rationales
« Option l:High-carbohydrate meals will worsen GERD.
• Option 2:Alcohol decreases lower esophageal sphincter tone and wT
ill
make GERD worse.
• Option 3:Obesity increases abdominal pressure and will worsen
GERD.
• Option 4:Peppennint decreases lower esophageal sphincter tone and
will make GERD w’orse.
[Page Reference: 10581
Question 5 . Prior to initiating therapy with misoprostol for a 30-year-old
woman, which question is essential for the APN to ask?
• correctl. "Is there any possibility that you might be pregnant?"
« 2. "Do you take any other pain medication?"
• 3. "Are you taking any antacids or [histamine-2] Hz blockers right
now?"
. 4."How long have you been suffering from arthritis?"
Rationales
■ Option 1: Misoprostol is an abortifacient and is Pregnancy Category
X. Determining whether the patient is pregnant is the top priority
before prescribing this medication.
• Option 2: Misoprostol is a cyto protective agent. Although it is
important to evaluate other medications the patient might take, it is
not the priority in this instance.
• Option 3:Although this is important to evaluate, it is not the priority.
■ Option 4:The diagnosis is not relevant to the safe administration of
misoprostol in this instance.
[Page Reference: 498]

Question 6. A 25-year-old female patient is about to embark on a 2-week
cruise for her honeymoon, and she is worried because she experiences
seasickness. She asks about using a scopolamine patch. Which advice would
the APN provide the patient about this medication?
• correct!. "Apply the patch behind your ear 4 hours before getting on
the ship."
• 2. "Change the patch every morning while on the ship."
• 3. "When you change the patch, put it behind the same ear."
. 4."Only apply the patch to your arm if you experience seasickness."
Rationales
• Option 1 :The patch should be applied behind the ear 4 hours before
traveling.
. Option 2:The patch can be left in place for up to 3 days.
1 Option 3:If therapy is still needed after 3 days, the new patch should
be placed behind the other ear.
• Option 4:The patch should be applied behind the ear 4 hours before
traveling.
[Page Reference: 497]
Question 7 . A patient consults the APN because of concerns about
experiencing repeated bouts of vertigo and nausea. The patient asks
whether anything can be prescribed to help. Which medication would be
most appropriate for this patient?
. 1. Prochlorperazine 10 mg oral tablet
• 2. Apre pitant 40 mg capsule
■ corrects. Meclizine 25 mg oral tablet
. 4.Dolasetron 100 mg tablet
Rationales
■ Option 1:Prochlorperazine is not usually effective for treating
vertigo.
Option 2:Aprepitant is used for nausea and vomiting in patients
receiving chemotherapy.

Option 3:Antihistamines act on the vestibular system and
chemo receptor trigger zone (CTZ) and thus are good for vertigo and
its associated nausea.
• Option 4:Doiasetron is used for preventing nausea and vomiting after
surgery or chemotherapy.
[Page Reference: 494]
Question S. A patient is to start taking esomeprazole for the treatment of
gastroesophageal reflux disease (GERD). Which instruction must the APN
give the patient regarding this medication?
• l.Take this medication with every meal.
• correct2 . Take the medication at least 1 hour before a meal.
• 3.Take the medication 1 to 3 hours after meals.
. 4.Take the medication every time you experience heartbum.
Rationales
• Option 1: Esomeprazole is most effective when given 1 hour prior to a
meat and it is not taken with every meal.
• Option 2:Esomeprazole is most effective when given 1 hour prior to a
meal.
. Option 3:Antacids should be taken 1 to 3 hours after meals and at
bedtime.
• Option 4: Esomeprazole should be taken daily for several weeks to
treat GERD. If the patient has no relief of symptoms, he or she needs
further investigation.
[Page Reference: 10591
Question 9 . Which medication works by binding to the base of ulcers and
gastric erosions, thus forming a protective barrier?
• 1 . M etoc lopramide
• corrects. Sucralfate
• 3. Aluminum carbonate
• 4. Bismuth subsalicylate

Rationales
• Option 1 : Metoclopramide is a prokinetic agent. It does not have the
described mechanism of action.
• Option 2:Sucralfate is a cyto protective agent and binds to the base of
ulcers and erosions.
• Option 3:Aluminum carbonate is an antacid. It does not have the
described mechanism of action.
• Option 4:Bismuth subsalicylate has numerous uses, including the
treatment of diarrhea. It does not have the described mechanism of
action.
[ P a g e Reference: 4 9 1 ]
Question 1 0 . A patient comes to the clinic complaining of a 2-day history7 of
diarrhea. He receives two tablets of diphenoxylate HC1 with atropine sulfate
to take orally as needed for each loose stool. The APN should inform him
that he may experience which symptom(s)?
« l . A slower heart rate than normal
■ 2 . The need to urinate frequently
• 3 . An increase in appetite
. correct!. Drowsiness and dizziness
Rationales
• Option l:This medication occasionally causes tachycardia.
• Option 2 The anticholinergic effects of the medication may cause
urinary retention.
■ Option 3:Enhanced appetite is not caused by this medication.
• Option 4: Diphenoxylate with atropine may cause sedation and
possibly dizziness.
[ P a g e Reference: 485]
Question 1 1 . When initiating long-term drug therapy with proton pump
inhibitors (P Pls) for patients with severe gastroesophageal reflux disease
(GERD), which of these is one of the four goals of treatment?
• correct!. To reduce symptoms of reflux

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• 2 .To remove barriers to adherence
. 3 .To prevent the development of vitamin B - deficiency
• 4.To cure the disorder
Rationales
• Option 1 :Reducing the symptoms of reflux is one of the four goals of
treatment
• Option 2:Any disease process where lifestyle modifications are
central to management is prone to problems with adherence.
• Option 3:Vitamin B:2 deficiency is a potential adverse effect of long-
term treatment with PPIs and is not a goal of treatment.
• Option 4:GERD is a chronic condition. Patients with GERD must
understand the lifelong nature of the disorder and the need to
incorporate the treatment regimen into their everyday lives.
[Page Reference: 1 0 5 9 ]
Question 1 2 . For which patient is docusate contraindicated?
« l . A female patient with an 8-w’eek-old baby who is breastfeeding
• 2 . A female patient w’ho is 16 wT
eeks pregnant
« 3.A male patient who has just undergone a thoracotomy
• correct4. A male patient complaining of nausea and abdominal pain
Rationales
• Option 1:Surfactants are safe for pregnant and breastfeeding
women.
■ Option 2 :Surfactants are safe for pregnant and breastfeeding
women.
« Option 3:Surfactants are often prescribed postopera Lively to prevent
straining.
• Option 4 :Laxatives should not be taken in the presence of nausea,
vomiting, o r abdominal pain. The patient needs further investigation
to rule out a bowT
el obstruction.
[Page Reference: 5 1 7 ]

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Question 1 3 . The APN is writing orders for a patient who is scheduled to
have a colonoscopy 3 days from now. Which medication should be
prescribed to cleanse the entire gastrointestinal (GI ) tract prior to this
procedure?
■ c orre c tl . Po lye thyle ne g lyc o1
■ 2 . M e thylce llulose
• 3 . Lactulose
. 4. Doc us ate c alcium
Rationales
• Option 1: Polyethylene glycol is commonly used as bowel prep before
a colonoscopy.
» Option 2: Methylcellulose is a bulk-forming laxative used to treat
simple, chronic constipation.
• Option 3 :Lactulose is most commonly used to treat hepatic
encephalopathy.
■ Option 4:Docusate is a surfactant, or "stool softener/1 and wT
ould not
cleanse the colon sufficiently.
[ P a g e Reference: 5 0 2 ]
Question 1 4 . A 2 2-year-old female patient suffering from irritable bowel
syndrome (IBS) with constipation is seen at the clinic. Which medication
would be most appropriate for this patient?
• 1 . Lactulose
• 2 . Mineral oil
• corrects. Lubiprostone
. 4. Polycarbophil
Rationales
• Option l:Lactulose is a hyperosmolar laxative frequently prescribed
to lower ammonia levels in patients with hepatic failure.
. Option 2 :Mineral oil is normally used to lubricate the intestines and
is commonly used for fecal impaction. I t may decrease the absorption
of fat-soluble vitamins.

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Option 3:Lubiprostone is a chloride channel activator and is used to
treat IBS with constipation in women 18 years and older.
• Option 4:Polycarbophil is a bulk-forming laxative used to treat
simple, chronic constipation.
[Page Reference: 5 0 3 ]
Question 1 5 . Considering eradication rates, adverse effects, antimicrobial
resistance, and patient compliance, which regimen is most appropriate for
treatment ofH. pylon-induced peptic ulcer disease (PUD)?
■ correctl. Clarithromycin, amoxicillin, and a proton pump inhibitor
(PPI)
• 2 . Tetracycline, metronidazole, and a proton pump inhibitor (PPI)
• 3. Clarithromycin, tetracycline, and a histamine-2 (Hi) blocker
. 4. Metronidazole, amoxicillin, and a histamine-2 (H2) blocker
Rationales
« Option l:This regimen has fewer adverse effects, less antibiotic
resistance, and good-to-excellent eradication rates.
• Option 2 :Metronidazole has numerous adverse effects.
• Option 3:Proton pump inhibitors (PPIs) are the standard for
treating H. pylori -induced PUD.
• Option 4:Proton pump inhibitors (PPIs) are the standard for
treating H. py/ori-induced PUD. Metronidazole has numerous adverse
effects .
[ P a g e Reference: 1 0 6 2 ]
Question 1 6 . A 56-year-old male patient with diabetes has been taking a
proton pump inhibitor (PPI) daily as prescribed for gastroesophageal reflux
disease (GERD) but still experiences significant acid reflux. Which
medication could be prescribed to increase gastric emptying and help
improve his symptoms?
• correctl. Metoclopramide
■ 2 . Famotidine
• 3. Prochlorperazine

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Pharm Unit 6 Book Quiz

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